RELEASE OF INFORMATION TO PARENTS: My signature below indicates my consent for University of Mary Student Development staff and administration to discuss any and all information related to my request to live off-campus with either my parents or legal guardian(s) named below:

Names of parents or legal guardians:

______________________________________________________________________________________________________

Signature of student _________________________________________________________ Date _____________________

PERSONAL INFORMATION: Please use ink and print legibly.

Name (Last, First, MI) ___________________________________________________________________________________

Home Address ______________________________________ City _________________ State ________ Zip _______

Land Line Phone _____________________________________ Cell Phone ______________________________________

E-Mail ______________________________________________ U-Mary ID# _____________________________________

Age ________________ Date of Birth _____/_____/_____ Gender: Male Female

Marital status: Single Married Other Class status: Freshman Sophomore Transfer

Academic year for which permission is requested ___________________________________________________________

I plan to enroll: Fall Semester Spring Semester Summer Semester

Standard 13 of Community Standards for Students in the University of Mary Student Handbook (www.umary.edu/UM/StudentLife/StudentConduct/) states:

• Any student under the age of 21, who on the day classes begins has not completed a minimum of 60 credits from an accredited college or university, is required to live on-campus for the entire semester. Any exception to this policy must be approved in advance by the vice president for student development. Exceptions are limited to those situations identified in the policy (see “Reasons” below).

• A student who receives approval to live off-campus as a first-year student must renew his/her approval each subsequent year by submitting a new request. The renewal must be completed prior to the time the student registers for classes or the student will not be able to register.

• A student who provides false information to obtain university approval to live off-campus as well as, the student who has obtained legitimate approval to live off-campus consistent with the policy but whose living arrangements are not consistent with those approved, will be subject to the following penalties: a) the student will immediately be required to move on-campus and will forfeit his/her eligibility to submit another request for approval to live off-campus; b) the student will be financially responsible for all on-campus housing charges for the time he/she was in violation of this policy; 3) the student will be placed at a Level 4 Conduct Status, thereby becoming ineligible to participate in extra-curricular activities.

REASON FOR SEEKING APPROVAL TO LIVE OFF-CAMPUS: By policy, requests from students under the age of 21 to live off-campus limited to the circumstances listed below with approval contingent upon the student providing appropriate documenta-tion. Please check the reason you are seeking approval to live off-campus.

a. During the semester in question, the student will continue to live with his/her parents or court-appointed legal guardiansin the primary family home where the street address of the home is no more than 60 miles from the University of Marymain campus.

b. The student will reach his/her 21st birthday during the semester in question.

c. The student has already lived on-campus for four semesters at the University of Mary or at another accredited college or university (if at another college or university, attach appropriate documentation).

d. The student is married (attach a copy of the marriage certificate). Students with plans to marry during the semester in question will be required to live on-campus up to the date of the wedding.

e. The student is the legal custodial parent or court-appointed custodial guardian of a minor child (attach a copy of a birth certificate and court-ordered custody agreement or other appropriate legal documentation to verify).

CONTINUED ON REVERSE SIDE

Request for Approvalto Live O�-Campus

IF MY REQUEST IS APPROVED, MY OFF-CAMPUS CONTACT INFORMATION WILL BE AS FOLLOWS:

Address ____________________________________________ City _________________ State ________ Zip _________

Land Line Phone _____________________________________ Cell phone ________________________________________

PARENT/LEGAL GUARDIAN APPROVAL:

Signature of parent(s) or guardian(s) __________________________________________________ Date ________________

Parent(s) or guardian(s) name(s) (Please print) ________________________________________________________________

Parent(s) or guardian(s) Address __________________________________________________________________________

City _______________________________________ State ______________ Zip ___________________________________

Parent(s) or guardian(s) Phone Numbers: Land Line ________________________ Cell phone ________________________

Office Phone ________________________

SUBMIT COMPLETED FORMS ALONG WITH ALL SUPPORTING DOCUMENTATION TO:

Student Development OfficeRoom 1503, Benedictine Center for Servant LeadershipUniversity of Mary7500 University DriveBismarck, ND 58504(701) 355-8265

The University of Mary assumes no responsibility to make exceptions to its policy for students who sign a rental agreement, lease or make any other arrangement for off-campus housing before obtaining the approval of the Vice President for Student Development. The university reserves the right to require documentation as it deems necessaryto verify the information submitted with requests. Requests should be submitted at least 30 days prior to the semester in question. Students who need accommodations because of a disability should contact Student Accessibility Services, (701-355-8264) located in the Student Success Center on the lower level of the Welder Library.

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